Tex. Gov't Code Section 532.0401
Review of Prior Authorization and Utilization Review Processes

The commission shall:

(1)

in accordance with an established schedule, periodically review the prior authorization and utilization review processes within the Medicaid fee-for-service delivery model to determine whether those processes need modification to reduce authorizations of unnecessary services and inappropriate use of services;

(2)

monitor the prior authorization and utilization review processes within the Medicaid fee-for-service delivery model for anomalies and, on identification of an anomaly in a process, review the process for modification earlier than scheduled; and

(3)

monitor Medicaid managed care organizations to ensure that the organizations are using prior authorization and utilization review processes to reduce authorizations of unnecessary services and inappropriate use of services.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.

Source: Section 532.0401 — Review of Prior Authorization and Utilization Review Processes, https://statutes.­capitol.­texas.­gov/Docs/GV/htm/GV.­532.­htm#532.­0401 (accessed Jun. 5, 2024).

532.0001
Definition 532.0051
Commission Administration of Medicaid 532.0052
Streamlining Administrative Processes 532.0053
Grievances 532.0054
Office of Community Access and Services 532.0055
Service Delivery Audit Mechanisms 532.0056
Federal Authorization for Reform 532.0057
Fees, Charges, and Rates 532.0058
Acute Care Billing Coordination System 532.0059
Recovery of Certain Third-party Reimbursements 532.0060
Dental Director 532.0061
Alignment of Medicaid and Medicare Diabetic Equipment and Supplies Written Order Procedures 532.0101
Financing Optimization 532.0102
Retention of Certain Money to Administer Certain Programs 532.0103
Biennial Financial Report 532.0151
Streamlining Provider Enrollment and Credentialing Processes 532.0152
Use of National Provider Identifier Number 532.0153
Enrollment of Certain Eye Health Care Providers 532.0154
Rural Health Clinic Reimbursement 532.0155
Rural Hospital Reimbursement 532.0156
Reimbursement System for Electronic Health Information Review and Transmission 532.0201
Data Collection System 532.0202
Information Collection and Analysis 532.0203
Public Access to Certain Data 532.0204
Data Regarding Treatment for Prenatal Alcohol or Controlled Substance Exposure 532.0205
Medical Technology 532.0206
Pilot Projects Relating to Technology Applications 532.0251
Definition 532.0252
Implementation of Certain Provisions 532.0253
Electronic Visit Verification System Implementation 532.0254
Information to Be Verified 532.0255
Compliance Standards and Standardized Processes 532.0256
Recipient Compliance 532.0257
Health Care Provider Compliance 532.0258
Health Care Provider: Use of Proprietary System 532.0259
Stakeholder Input 532.0260
Rules 532.0301
Bill of Rights and Bill of Responsibilities 532.0302
Uniform Fair Hearing Rules 532.0303
Support and Information Services for Recipients 532.0304
Nursing Services Assessments 532.0305
Therapy Services Assessments 532.0306
Wellness Screening Program 532.0307
Federally Qualified Health Center and Rural Health Clinic Services 532.0351
Tailored Benefit Packages for Certain Categories of Medicaid Population 532.0352
Waiver Program for Certain Individuals with Chronic Health Conditions 532.0353
Buy-in Programs for Certain Individuals with Disabilities 532.0401
Review of Prior Authorization and Utilization Review Processes 532.0402
Accessibility of Information Regarding Prior Authorization Requirements 532.0403
Notice Requirements Regarding Coverage or Prior Authorization Denial and Incomplete Requests 532.0404
External Medical Review 532.0451
Hospital Emergency Room Use Reduction Initiatives 532.0452
Physician Incentive Program to Reduce Hospital Emergency Room Use for Non-emergent Conditions 532.0453
Continued Implementation of Certain Interventions and Best Practices by Providers 532.0454
Health Savings Account Pilot Program 532.0455
Durable Medical Equipment Reuse Program
Green check means up to date. Up to date

Accessed:
Jun. 5, 2024

§ 532.0401’s source at texas​.gov